CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2023 ending 06/30/2023 Date of Report:07/25/2023 Page: 1
List order: No List
Payclass Filters:MED
Bill Flag Filter:RBPU
Eligibility Filter:All
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 10000 34325.50000 1276331.7000 37.1832
Subtotal (Total Children Is Unduplicated) 10000 34325.50000 1276331.7000 37.1832
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 27 51.500000 3862.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 29 51.000000 3787.5000 74.2647
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 6 9.500000 712.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 16 27.500000 2062.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 8 14.000000 1050.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 15 25.500000 1912.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 8 14.000000 1050.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 6 11.000000 825.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 23 44.500000 2469.7500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 42 74.000000 4107.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 546 991.750000 74342.2500 74.9607
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 503 907.500000 67797.0000 74.7074
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 79 135.500000 10162.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 242 440.000000 33000.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 157 291.000000 21825.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 197 328.500000 24637.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 544 989.000000 54834.0000 55.4439
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 749 1378.500000 76506.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 167 272.500000 20237.5000 74.2661
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 94 175.000000 13125.0000 75.0000
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97166TLGT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
SCREEN-T1023-SCREENING 22 22.000000 1100.0000 50.0000
SPCH-92521TL-EVAL OF SPEECH FLUENCY 1 2.000000 102.8200 51.4100
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 10 11.000000 565.5100 51.4100
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 4 4.000000 205.6400 51.4100
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 6 19.000000 1002.6300 52.7700
Subtotal (Total Children Is Unduplicated) 2116 6291.750000 421386.1700 66.9744
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 365 1646.000000 82275.0000 49.9848
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 174 502.250000 25081.0000 49.9373
OCCT-97530-OT SESSION BY LICENSED OT 8 11.000000 791.5600 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 5 7.500000 539.7000 71.9600
OCCT-97530TL-OT SESSION BY LICENSED OT 70 322.500000 23045.1900 71.4580
OCCT-97530TLGT-OT SESSION BY LICENSED OT 35 103.000000 7411.8800 71.9600
OCCT-97530TLGTHM-OT SESSION BY OT ASST 1 1.000000 57.6000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 13 22.000000 1583.1200 71.9600
PHY-97110TL-PT SESSION BY LICENSED PT 114 517.500000 37203.3200 71.8905
PHY-97110TLGT-PT SESSION BY LICENSED PT 25 37.000000 2662.5200 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 10 11.000000 791.5600 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 8 10.500000 755.5800 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 121 521.750000 37467.5300 71.8113
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 38 94.000000 6764.2400 71.9600
Subtotal (Total Children Is Unduplicated) 802 3807.000000 226429.8000 59.4772
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Total 44424.250000 1924147.6700 43.3130
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Number of Children (Unduplicated) With at Least One Service 10213
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Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 7 7.000000 350.0000 350.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7 7.000000 350.0000 350.0000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 4 3.000000 111.6000 0.0000
U 0 0.000000 0.0000 0.0000
B 217 133.750000 5157.2000 0.0000
P 158 128.250000 5333.1500 5333.9900
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 379 265.000000 10601.9500 5333.9900
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 210 326.500000 12902.5500 0.0000
U 0 0.000000 0.0000 0.0000
B 2014 3254.750000 126793.8000 0.0000
P 769 1270.750000 50602.4000 50212.8000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2993 4852.000000 190298.7500 50212.8000
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 38 22.250000 827.7000 0.0000
U 0 0.000000 0.0000 0.0000
B 3018 1916.250000 71284.5000 34977.2400
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3056 1938.500000 72112.2000 34977.2400
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 64 51.000000 2348.4000 0.0000
U 0 0.000000 0.0000 0.0000
B 1192 983.000000 45013.8000 0.0000
P 1907 1563.750000 66459.5000 66403.7000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3163 2597.750000 113821.7000 66403.7000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 196 195.750000 7548.9400 0.0000
U 0 0.000000 0.0000 0.0000
B 4271 4552.000000 186160.9300 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4467 4747.750000 193709.8700 0.0000
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 82 67.750000 2520.3000 0.0000
U 0 0.000000 0.0000 0.0000
B 9656 8692.250000 367300.8000 0.0000
P 3 3.250000 231.2600 1.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9741 8763.250000 370052.3600 1.0000
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 1.000000 55.5000 0.0000
P 1 4.000000 200.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2 5.000000 255.5000 0.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 13 13.000000 685.6200 0.0000
U 0 0.000000 0.0000 0.0000
B 998 1065.750000 56726.2700 74.4000
P 1361 1435.500000 66436.3500 66436.4200
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2372 2514.250000 123848.2400 66510.8200
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 115 114.500000 7888.4100 0.0000
U 0 0.000000 0.0000 0.0000
B 1313 1196.000000 58778.4900 0.0000
P 2320 2133.500000 104613.6700 104538.2100
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3748 3444.000000 171280.5700 104538.2100
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 9 8.750000 325.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 2430 2318.250000 110078.3500 0.0000
P 3246 2968.000000 135780.6400 135771.3400
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5685 5295.000000 246184.4900 135771.3400
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2736 2867.000000 126736.5900 0.0000
P 1439 1450.250000 61638.5000 60837.9500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4175 4317.250000 188375.0900 60837.9500
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 19 33.500000 1246.2000 0.0000
U 0 0.000000 0.0000 0.0000
B 2790 4054.750000 170991.6000 139.5000
P 1088 1589.250000 71019.1500 71019.3300
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3897 5677.500000 243256.9500 71158.8300